Renal toxicity after allogeneic bone marrow transplantation: The combined effects of total-body irradiation and graft-versus-host disease
Renal toxicity after allogeneic bone marrow transplantation: The combined effects of total-body irradiation and graft-versus-host disease
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DOI：
10.1200/jco.1996.14.2.579
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发表时间：
1996-02-01
影响因子：
45.3
通讯作者：
Chapuis, B
中科院分区：
文献类型：
--
作者：
Miralbell, R;Bieri, S;Chapuis, B
目的：目的：回顾性分析异基因骨髓移植（BMT）后肾功能不全的累积危险概率及相关因素。患者与方法：1984年10月~ 1994年7月，84例恶性血液病患者在接受大剂量化疗和全身照射（TBI）预处理后接受了异基因BMT。本研究纳入了79例预处理前肾功能正常的患者。预处理包括高剂量环磷酰胺，无（n = 46）或与（n = 33）其他药物（柔红霉素，白消安，阿糖胞苷，塞替派），然后TBI。腹部中心的TBI剂量为10戈伊（24例）、12戈伊（32例）和13.5戈伊（23例）。在48例患者中进行了体外T细胞去除。评估了氨基糖苷类、万古霉素、阿替霉素和环孢素的BMT后肾毒性。至肾功能不全的时间定义为至血清肌酐（SCr）水平持续升高超过110 μ mol/L的时间。结果：全组18个月无肾功能障碍生存率（RDFS）为77%，多因素分析显示，仅TBI剂量和GvHD与肾功能障碍显著相关。在接受10、12和13.5戈伊照射的患者中，18个月RDFS的概率分别为95%、74%和55%。无GvHD和有GvHD患者的18个月RDFS概率分别为88%和61%。结合这两个变量，我们定义了两个风险类别：低风险（即，10戈伊TBI伴/不伴GVHD和12戈伊TBI不伴GVHD）和高风险（即，12戈伊TBI伴GVHD和13.5戈伊TBI伴/不伴GVHD）。预测18个月RDFS率分别为93%和52%的低，高risk groups.Conclusion：肾功能不全后，同种异体骨髓移植是密切相关的TBI剂量（和剂量每部分）和GVHD的存在。如果TBI剂量大于12戈伊（分次每日两次，持续3天），则应推荐肾屏蔽。此外，在发生GvHD的高风险病例中（例如，无关的同种异体BMT，无T细胞耗竭），这些数据表明应避免肾脏剂量超过10戈伊。(C)1996年，美国临床肿瘤学会。
Purpose: To evaluate retrospectively the cumulative risk probability and factors correlated with renal dysfunction after allogeneic bone marrow transplantation (BMT).Patients and Methods: From October 1984 to July 1994, 84 patients with malignant hematopoietic diseases received allogeneic BMT after conditioning with high-dose chemotherapy and total-body irradiation (TBI). Seventy-nine patients with normal renal function before conditioning are included in this study. Conditioning included high-dose cyclophosphamide without (n = 46) or with (n = 33) other agents (daunorubicin, busulfan, cytarabine, and thiotepa) followed by TBI. The TBI dose prescribed to the center of the abdomen was 10 Gy for 24 patients, 12 Gy for 32, and 13.5 Gy for 23. In vitro T-cell depletion was undertaken in 48 cases. The post-BMT nephrotoxicity of aminoglycosides, vancomycin, amphotericin, and cyclosporine was assessed. Time to renal dysfunction was defined as the time to a persistent increase of serum creatinine (SCr) level greater than 110 mu mol/L. The potential influence of sex, age, diagnosis, chimerism, and graft-versus-host disease (GVHD) on renal dysfunction was also assessed.Results: The 18-month probability of renal dysfunction-free survival (RDFS) for the whole group was 77%.Only TBI dose and presence of GvHD were significantly correlated with renal dysfunction by multivariate analysis. The 18-month probabilities of RDFS were 95%, 74%, and 55% for the patients conditioned with 10, 12, and 13.5 Gy, respectively. The 18-month RDFS probabilities were 88% and 61% for patients without and with GvHD, respectively. Combining both variables, we have defined two risk categories: low-risk (ie, 10 Gy TBI with/without GVHD and 12 Gy TBI without GVHD) and highrisk (ie, 12 Gy TBI with GVHD and 13.5 Gy TBI with/without GVHD). The predicted 18-month RDFS rates were 93% and 52% for the low- and high-risk groups, respectively.Conclusion: Renal dysfunction after allogeneic BMT is strongly related to the delivered TBI dose (and dose per fraction) and to the presence of GVHD. Renal shielding should be recommended if a TBI dose greater than 12 Gy (fractionated twice daily over 3 days) is to be prescribed. Furthermore, in those cases with a high risk of developing GvHD (eg, unrelated allogeneic BMT, absence of T-cell depletion), these data suggest that kidney doses greater than 10 Gy should be avoided. (C) 1996 by American Society of Clinical Oncology.